The hiring range for this role is:  

107,666.00 - 150,995.00

This is the lowest to highest salary we, in good faith, believe we would pay for this role at the time of this posting.  We may ultimately pay more or less than the hiring range and this hiring range may also be modified in the future. A candidate’s position within the hiring range may be based on several factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, shift, travel requirements, and business or organizational needs. This job is also eligible for annual bonus incentive pay. 

We offer a comprehensive package of benefits including paid time off, 11 holidays, medical/dental/vision insurance, generous 401(k) matching, lifestyle spending account and many other benefits to eligible employees. 

Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law. 

 

Job Description Summary:

Responsible for leading multiple projects, services and associated deliverables related to HEDIS, Care Management Programs and the activities for the Federal Employee Program (FEP) in support of the integrated care model. Functions as the Plan liaison clinical subject matter expert, assimilating information and developing strategic recommendations to proactively address Plan clinical needs. Leads and collaborates with multiple subject matter experts and various members of the integrated team to develop clinical recommendations and improve HEDIS Performance. Engage in cross-functional projects to support the Enterprise in developing Programs, resources to meet Plan needs.

Responsibilities include but are not limited to:

Lead the oversight of the analyses, evaluation, and synthesis of the FEP Care Management programs and HEDIS programs with an integrated approach to support the Local Plans and their integrated care management models. Manages multiple projects for multi-faceted programs associated with care management. Collaborates with the business owners for Care Management Programs. Activities include but are not limited to: Coordinating Plan visits (on-site and virtual), monthly meetings, acts as a liaison for the FEP Clinical, Business Operations, Innovations, and External Care and Operations to ensure the application of consistent, cost-effective methodologies to support BCBSA Corporate goals. Communicate pathways for Plan engagement (e.g. annual FEP Conferences, BlueWeb, FEP Hub, etc.). Work with the various Plans and FEP stakeholders to analyze and improve the Local Plan performance, collaborate with Plan Management teams and other internal stakeholders to effectively capture Plan issues and/or concerns.

Partners with various stakeholders to resolve complex plan issues utilizing available resources and content expertise in support of division budget and objectives. Develop Plan communication strategies to assure care management interventions are consistent with benefit administration and interpretation; participate on internal and external organization’s advisory groups; provide oversight of benefit cost initiatives through cross-functional departmental/divisional teams. Assists Plans with using methodologies and strategies to support achievement and maintain high levels of FEP performance.

Maintains knowledge and expertise on current and emerging healthcare issues (particularly HEDIS, accreditation, Population Health/case, and disease management) Provides direction and guidance on operational policy and identification of critical priorities.

Provide guidance in the financial aspects of the Local Plan’s financial budgets in relation to DM/CM programs run locally by the Plan or the Plan Vendor.

Translates trend information into strategic action plans resulting in value-added resources that address Plan business needs. May lead, participate, and partnering projects from planning to implementation.

Provide strategic follow-up and clinical recommendations post on-site plan visits and meetings. Provides support to Quality Teams regarding the HEDIS, CAHPS and accreditation initiative.

Acts as a liaison, resource, and partner with Plans, internal BCBSA staff and other external partners., Provides guidance on FEP Program interpretation. Ensures development and/or implementation of required strategies, programs, and benefits. Leverages input/feedback for developing new strategies, programs, and benefits from internal and external partners.

Required Education, Certifications and Experience:

Education:

Required - Bachelors Degree, Nursing

Certifications:

Required - Registered Nurse - State Licensure and/or Compact State LicensureRequired - Certification in case management (CCM)Preferred - CBDCE Certified Diabetic Educator or Certified Health EducatorPreferred - Academy of Healthcare Management (AIHM)

Experience

5 years required - Related managed care and business experience which demonstrates knowledge and understanding of PPO operations and care management.

Skills

Professional nurseHealth administration or public health degreeRelated managed care and business experience which demonstrates knowledge and understanding of PPO operations and care management.Advanced project management skills for planning and executing multiple projects and a detail orientation to ensure compliance with accreditation standards and accuracy of statistics are essential.Ability to create strategies that support initiatives and translate these into action plans.Ability to budget and prepare cost projections.Advanced leadership skills with the ability to delegate and motivate others.Ability to handle multiple projects, working under pressure and meeting deadlines.Advanced presentations skills with the ability to plan, facilitate and present at meetings, conferences, etc.Ability to prioritize and identify critical issues.Ability to work independently, as a team member, and as a team leader.Advanced analytical skills with the ability to analyze and interpret data and conduct advanced analysis.Ability to interact effectively with senior management, both internal/external to the Association.Excellent interpersonal and communication skills, both written and oral.Advanced process management skills, with demonstrated customer focus.Advanced conflict management skills.Ability to translate complex, technical and/or quantitative information in a clear, concise and understandable manger.Advanced time and resource management and problem-solving skills.Ability to collaborate with multiple levels of stakeholders.Ability to provide interactive information at a professional speaker/consultative level.Proficiency with the use of a variety of software applications (e.g., Microsoft Word, Excel, and PowerPoint). Familiarity with the access, navigation, search and extradition of information via the Internet.

People Management

No

Travel:

26-50%

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